Headaches and Migraines

Headache and Migraine Relief

Join hundreds of patients who have had permanent relief from headaches and migraines!  Our published treatment program reduces and eliminates pain quickly and efficiently.

Effective, Research-Based Treatments for Headaches and Migraines

Over 90% success rate in reduction of headache frequency and intensity using electric dry needling, spinal manipulation, and myofascial release work for qualified patients who suffer from migraines, tension-type, and cervicogenic headaches.

Immediate Results

Feel a reduction in headache and migraine pain after your first session with our published protocol.

Pain Reduction that Lasts

At 3 months post-treatment patients still have the same reduction in headache and migraine pain


We target structures in the upper neck and head to desensitize the nerve responsible for headache and migraine pain.

Improved Concentration

Treatments will help to improve cognitive performance.

Patient Testimonial

"To tell you that he has been working miracles is an understatement. My daily headache pain level has decreased from a 9 to a 5, and that's only after 4 sessions"

Cervicogenic Headache

Get Relief from Headaches and Migraines Now

Reclaim days of your life back. Get the best treatment to alleviate your headaches and migraines in Miami.

Headaches: What Type Do You Have?

Patients typically suffer from three primary classifications of headaches: cervicogenic, tension-type, and migraines.  Cervicogenic headaches are defined as either right-sided or left-sided headaches that do not change sides within the same headache.1Moreover, patients that suffer from cervicogenic headaches typically experience neck pain from movement and/or palpation and limited cervical range of motion, which often reproduces familiar headache symptoms.1While migraine headaches have moderate to severe intensity and can occur with or without aura, they are also typically unilateral headaches that are aggravated by routine physical activity.2In contrast, the International Headache Society defines tension-type headaches as having mild or moderate pain intensity on both sides of the head equally, pressing/tightening (non-pulsating) quality, phonophobia or photophobia without nausea or vomiting, and pain that is not aggravated by routine activity or attributed to another disorder.3, 4

Understanding Your Headaches and Migraines Better

Want to understand where your headache pain is coming from? Listen to our 5-Minute video with one of our experts, Dr. Raymond Butts, a well-published therapist in successful conservative treatment of headaches.

Cervicogenic Headache

Click Below to Read Our Published Research on Treatment for Headaches and Migraines

Spinal Manipulation and Perineural Electrical Dry Needling in Patients with Cervicogenic Headaches: A Multicenter Randomized Clinical Trial

Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache: A Multicenter Randomized Clinical Trial

Pain, Migraines, & Mobility of the Cervical Vertebrae with Winback Tecartherapy

A Deep Dive Into the Science

The sections below are meant for those who are interested in the science and research about headaches and migraines that has contributed, in part, to the physical therapy treatment protocols we use at Symmetry Physical Therapy, Miami. 

Headaches Migraines Miami Physical Therapy

Pathophysiology of Headaches

While all three major headache types have unique characteristics, there seems to be some commonality in their pathophysiology, as all three are mediated, in part, via the trigeminocervical nucleus of the brainstem.3, 5, 6Thetrigeminocervical nucleus is the primary location of the cell bodies of the trigeminal nerve, which is responsible for the sensation of the face and the muscles of mastication (i.e. the chewing muscles).  Interesting, the spinal aspect of the trigeminocervical nucleus overlaps with the dorsal horn neurons at vertebral segments C1-C3.7This anatomy is significant, as the dorsal horn neurons are responsible for receiving pain information from the upper neck and posterior occiput.7


The overlap between the trigeminocervical nucleus and the C1-C3 dorsal horns creates confusion, which results in the central nervous system interpreting some neck pain as trigeminal pain, which is propagated from the back of the occiput to the face via the ophthalmic, maxillary, and mandibular branches.8 This explains how headaches that seem to start in the posterior aspect of the head lead to pain and pressure in the forehead, the eyes, sinuses, and lateral face.  Notably, the mechanism of action of some migraine meds (e.g. triptans) specifically attempts to decrease the sensitivity of the trigeminocervical nucleus by blocking CGRP.9 Given the overlap of the dorsal horn neurons at C1-C3 and the trigeminocervical nucleus, it follows that physical therapy that not only decreases neural inflammation but also blocks pain from being delivered from the neck to the central nerve system would be particularly powerful in treating headaches.

Spinal Manipulation and Mobilization for Headaches and Migraines

A recent multi-clinical site trial published by Symmetry Physical Therapy Therapists found that upper cervical and thoracic manipulation was superior to mobilization and exercise for this patient population.12According to an International Multidisciplinary Task Force, spinal manipulation should be considered as one of several first-line treatments for headaches.10 A systematic review by Bronfort et al. reported that mobilization and manipulation of the cervical spine were effective treatments for patients with cervicogenic headaches.11


A number of systematic review articles have concluded that spinal mobilization and manipulation that targets the cervical and thoracic spine is useful for patients suffering from tension-type13 and migraine headaches.14Jung et al. found that spinal manipulation of the cervical and thoracic spine to be superior to sub-occipital release and massage for tension-type headaches,15 whileChaibiet al. reported that spinal manipulation may be equally as affective as prophylactic drugs for migraines.16

Headaches and Migraines physical therapy treatment in Miami
Headache and Migraine physicalt therapy treatment in Miami

Dry Needling for Headaches and Migraines

While the terminology, philosophy, and theoretic construct differ between western-based dry needling and traditional acupuncture, the procedure of inserting monofilament needles is essentially the same.17Therefore, manual and electric dry needling is used synonymously with manual and electroacupuncture related to headaches. A recent multi-clinical site randomized control trial published by Symmetry physical therapists of 142 patients with cervicogenic headaches found that electric dry needling and spinal manipulation resulted in significant reductions in medication intake along with headache intensity, disability, frequency, and duration in patients with cervicogenic headaches. patients were able to acheive long lasting migraine and headache relief. 18Venancio et al. further reported that acupuncture was equally as effective as lidocaine and BOTOX treatment for reducing the frequency, duration, and intensity of cervicogenic headaches.19


In an overview of 8 Cochrane reviews, electroacupuncture was also shown to be an evidence-based strategy for tension-type headaches, migraine headaches, and neck pain.20According to Cochrane Review by Linde et al., acupuncture is equivalent to physical therapy, massage, and relaxation training for tension-type headaches.21The NICE guidelines recommend up to 10 sessions of acupuncture for the prophylactic management of migraine headaches when medication is ineffective or not appropriate.22 For migraines, acupuncture seems to be as effective as some medications23 and may be an appropriate addition to routine primary care for migraine prophylaxis24 via its inhibitory effects on the trigeminocervical nucleus.25 

Manual Therapy and Exercise for Headaches and Migraines

A number of randomized control trials have demonstrated that myofascial and soft tissue techniques targeting the head, neck, and scapula, are effective treatment strategies for cervicogenic and tension-type headaches.26Exercise has also resulted in clinically meaningful reduction in pain associated with these headache types.26, 27

Neck pain specialist
Headaches and Migraines physical therapy treatment in Miami

WinbackTecar Therapy for Headaches and Migraines

Patients continue to have success with the use of WinbackTecar Therapy for cervicogenic, tension-type and Migraine headaches.28In a recent study by Lee et al., Tecar Therapy improve headache pain, tenderness, and neck function, particularly when used as part of a multi-modal treatment approach.

Symmetry Physical Therapy is one of the only Physical Therapy Clinics in Miami to offer this technology for the treatment of headaches.

How does Physical Therapy Help for Headaches and Migraines?

  • Long-lasting Migraine and headache relief
  • Mobilization and manipulation of the cervical and thoracic spine are successful treatment strategies for patients with cervicogenic headaches, a recent multi-clinical site randomized control trial suggests manipulation may be advantageous in this patient population.
  • A number of review articles have reported that manipulation and/or mobilization of the cervical and thoracic spine is a useful treatment strategy for tension-type headaches.
  • A number of randomized control trials have demonstrated that myofascial and soft tissue release of the muscle on the head, neck, and scapula are effective treatment strategies for cervicogenic and tension-type headaches.
  • Exercise has resulted in clinically meaningful reductions in pain and disability secondary to cervicogenic and tension-type headaches.
  • In an overview of 8 Cochrane reviews, electroacupuncture was shown to be an evidence-based treatment strategy for tension-type headaches, migraines, and neck pain.
  • A recent multi-clinical site randomized control trial of 142 patients found that electric dry needling and spinal manipulation resulted in a significant reduction in medication intake along with headache intensity, disability, frequency, and duration in patients with cervicogenic headaches.

Headache Relief that Lasts

Get Better, Stay Better, and Live without Pain

Get Relief Now

Reclaim days of your life with Symmetry Physical Therapy's published physical therapy headache relief treatments.  We are here to help.

Headache and Migraine Treatment Miami

Works Cited

  1. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache. 1998;38(6):442-5.
  2. Blum ASS, Riggins NY, Hersey DP, Atwood GS, Littenberg B. Left- vs right-sided migraine: a scoping review. J Neurol. 2023;270(6):2938-49.
  3. Rossi P, Vollono C, Valeriani M, Sandrini G. The contribution of clinical neurophysiology to the comprehension of the tension-type headache mechanisms. Clin Neurophysiol. 2011;122(6):1075-85.
  4. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
  5. Sedy J, Rocabado M, Olate LE, Vlna M, Zizka R. Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain. Medicina (Kaunas). 2022;58(10).
  6. Puledda F, Silva EM, Suwanlaong K, Goadsby PJ. Migraine: from pathophysiology to treatment. J Neurol. 2023;270(7):3654-66.
  7. Fernandes EC, Carlos-Ferreira J, Luz LL, Kokai E, Meszar Z, Szucs P, et al. Processing of trigeminocervical nociceptive afferent input by neuronal circuity in the upper cervical lamina I. Pain. 2022;163(2):362-75.
  8. Castien R, De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Front Neurol. 2019;10:276.
  9. Erdener SE, Kaya Z, Dalkara T. Parenchymal neuroinflammatory signaling and dural neurogenic inflammation in migraine. J Headache Pain. 2021;22(1):138.
  10. Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, et al. Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009;32(2 Suppl):S141-75.
  11. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.
  12. Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Penas C, Hagins M, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016;17:64.
  13. Jiang W, Li Z, Wei N, Chang W, Chen W, Sui HJ. Effectiveness of physical therapy on the suboccipital area of patients with tension-type headache: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019;98(19):e15487.
  14. Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, et al. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache. 2019;59(4):532-42.
  15. Jung A, Eschke RC, Struss J, Taucher W, Luedtke K. Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis. Cephalalgia. 2022;42(9):944-65.
  16. Chaibi A, Benth JS, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. Eur J Neurol. 2017;24(1):143-53.
  17. Butts R, Dunning J, Perreault T, Maurad F, Grubb M. Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals. International Journal of Physical Medicine and Rehabilitation. 2016;216(4:2).
  18. Dunning J, Butts R, Zacharko N, Fandry K, Young I, Wheeler K, et al. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. Spine J. 2021;21(2):284-95.
  19. Venancio RA, Alencar FG, Jr., Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009;27(1):46-53.
  20. Lee MS, Ernst E. Acupuncture for pain: an overview of Cochrane reviews. Chin J Integr Med. 2011;17(3):187-9.
  21. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009(1):CD007587.
  22. Carville S, Padhi S, Reason T, Underwood M, Guideline Development G. Diagnosis and management of headaches in young people and adults: summary of NICE guidance. BMJ. 2012;345:e5765.
  23. Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016(6):CD001218.
  24. Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008;28(9):969-79.
  25. Yang CP, Chang MH, Liu PE, Li TC, Hsieh CL, Hwang KL, et al. Acupuncture versus topiramate in chronic migraine prophylaxis: a randomized clinical trial. Cephalalgia. 2011;31(15):1510-21.
  26. Cote P, Yu H, Shearer HM, Randhawa K, Wong JJ, Mior S, et al. Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur J Pain. 2019.
  27. Machado-Oliveira L, da Silva Gauto YO, de Santana Neto FJ, da Silva MG, Germano-Soares AH, Diniz PRB. Effects of Different Exercise Intensities on Headache: A Systematic Review. Am J Phys Med Rehabil. 2020;99(5):390-6.
  28. Winback. Pain, migraines & mobility of the cervical vertebrae with winback tecartherapy: WInback [cited 2023 September 27, 2023].
  29. Lee H, Shim J, Oh d. Effects of High-frequency Diathermy Integrated into Suboccipital Release on Tenderness and Neck Mobility and Disability in People with Chronic Tension-type Headache. Phys Ther Korea 2017;24(2):37-47.

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Symmetry Physical Therapy is a privately owned one-on-one, patient-centered physical therapy clinic in Downtown Miami/Brickell. Every treatment is with the same Doctor of Physical Therapy for the entire hour. Symmetry’s specialized, dedicated, and passionate team of physical therapists is fully committed to each patient’s success.

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